CD4 T-Cell Monitoring in HIV Management
Key Themes:
- Immune Reconstitution: Average CD4 count increases of approximately 200 cells in the first year of effective therapy
- Laboratory Variability: CD4 count fluctuations of up to 20% between measurements, causing potential patient concern
- Clinical Utility Debate: Discussion of whether routine CD4 monitoring remains necessary in stable patients
- Toxicity Monitoring: Importance of CD4 count monitoring in trials of new agents with potential lymphotoxicity
Notable Insights from Dr Sharon Walmsley:
- Despite some recommendations to reduce CD4 monitoring (“choosing wisely” initiatives), many patients value these numbers as reinforcement that treatment is working.
- CD4 counts remain important for guiding opportunistic infection prophylaxis decisions in patients with lower values.
- CD4 monitoring can serve as a motivational tool for patients struggling with adherence.
- In switch studies, CD4 counts typically remain stable when patients are already virologically suppressed.
